NEW YORK (Reuters) - Merck & Co on Tuesday said it is
expanding its "Merck for Mothers" program, which aims to reduce
pregnancy-related deaths from impoverished countries such as
Senegal and Zambia, to the United States - a stark reminder of
how far the country lags other wealthy nations on key measures
of health.

"As Americans, we simply should not accept that 46 countries
have lower rates" of reported maternal mortality, said Merck
Chief Executive Ken Frazier. The fact that U.S.
pregnancy-related deaths have nearly doubled since 1990 is
"appalling" and "something we ought to be ashamed of," he said.

"Given how sophisticated medical care is in this country, I
think most Americans would be astonished" that almost 900 women
die each year as a result of pregnancy or childbirth and 50,000
have close calls, Frazier said.

The U.S. drugmaker launched the $500 million global program
in 2011 to reduce pregnancy-related deaths, focusing on India,
Uganda and other poor countries with only rudimentary healthcare
systems.

However, pregnancy-related deaths in the United States have
risen from 7.2 per 100,000 live births in 1987 to 17.8 per
100,000 in 2009 (the latest year with reliable data), according
to the U.S. Centers for Disease Control and Prevention. The rate
among African-American women is more than triple that of white
women: 35.6 versus 11.7 deaths per 100,000 live births.

The deaths include any that occur while a woman is pregnant
or within a year after she gives birth, from any cause related
to or aggravated by pregnancy.

The leading maternal killers include cardiovascular disease,
venous thromboembolism, hemorrhage, hypertension and sepsis,
said Dr. Mary D'Alton of Columbia University Medical Center in
New York City, a specialist in high-risk maternal and fetal
medicine.

According to a study presented on Sunday at a meeting of the
American Heart Association, heart disease is the leading cause
of pregnancy-related deaths in California. "Women who give birth
are usually young and in good health," said Dr. Afshan Hameed of
the University of California, Irvine, who led the research. "So
heart disease shouldn't be the leading cause of
pregnancy-related deaths, but it is."

The reasons for the rise in maternal mortality are unclear.
Better reporting is part of it: some states only recently added
a "pregnancy" check box to death certificates, said Dr. Edward
McCabe, medical director of the March of Dimes.

"We're getting better data, yes, but what these data are
telling us is that we have an unacceptably high rate of
pregnancy-related mortality."

Another likely reason for the increase is the rising
prevalence of chronic diseases. Diabetes, chronic heart disease
and hypertension - which can occur as a result of obesity - have
become more common in women of reproductive age. And for
unexplained reasons, the 2009 H1N1 (swine flu) pandemic killed
many pregnant women in the United States: although pregnant
women account for about 1 percent of the U.S. population, they
made up 5 percent of the deaths, the CDC reported.

"Merck for Mothers" will provide $6 million to U.S. programs
in 10 states and three cities aimed at decreasing the number of
women who die as a result of being pregnant or giving birth.
Local programs include Baltimore Healthy Start, which works with
neighborhood clinics to improve prenatal and primary care for
pregnant women who have high blood pressure, diabetes and other
chronic conditions, and the Maternity Care Coalition in
Philadelphia, whose "Safe Start MOMobile" sends health advocates
into the homes of high-risk pregnant women.

The program will also work through the American Congress of
Obstetricians and Gynecologists to develop standardized
protocols for treating the leading causes of maternal death,
said Columbia's D'Alton. Currently, there is significant
variation in how obstetricians and hospitals treat
potentially-fatal obstetric emergencies such as postpartum
hemorrhaging and embolisms.

"There are no national guidelines about what to do in the
event of a maternal emergency," D'Alton said. "Variability is
the enemy of safety."

Merck is collaborating with the London School of Hygiene &
Tropical Medicine to assess whether its maternity programs in
Uganda, Zambia and other countries are making a difference, and
will publish data on what works and what doesn't.